Prognostic role of CMR in acute myocardial infarction

  • Lorenzo Monti
  • Elena Corrada
  • Patrizia Presbitero
  • Renato Bragato
  • Mirko Curzi
  • Luca Balzarini
Open Access
Poster presentation
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Keywords

Acute Myocardial Infarction Cardiac Magnetic Resonance Prognostic Role Left Ventricular Remodel Prognostic Accuracy 

Introduction

Cardiac Magnetic Resonance (CMR) provides a comprehensive non-invasive characterization of acute myocardial infarction (MI).

Purpose

to test whether a single CMR study may improve the prognostic stratification of MI patients.

Methods

29 patients were studied on day 3 ± 1 after a first MI, between June 2006 and April 2007. CMR included SSFP and T2 STIR sequences, first pass perfusion, Early (EGE: 1 to 2 minutes) and Late (LGE: 10 to 15 minutes) Gadolinium Enhancement. Subsequent clinical management was not affected from CMR results, and patients underwent the usual clinical and echocardiographic follow-up. In 2009 we tested the occurrence of the end-point of cardiac death or left ventricular (LV) remodelling (EDVi > 90 ml/m2 or LVEF < 50% at echocardiographic follow-up) in the studied population.

Results

At 23 ± 5 months follow-up, the endpoint was observed in 7 pts (25%): 1 cardiac death, 6 adverse LV remodeling. See Table 1 for the prognostic role of different CMR parameters: among the tested parameters, myocardial haemorrhage, observed in 8 pts (27%), has a unique 96,5% accuracy in predicting the endpoint, with a 100% NPV. Unexpectedly, LGE-based parameters such as total infarct mass and the presence MVO show prognostic accuracy similar to the echocardiographic LVEF <50%. The 7 pts reaching the endpoint show both MVO (globally present in 15 pts -51%-) and Myocardial Haemorrhage. It seems that the assessment of MVO should keep in account the total amount and not only the mere presence of MVO: this hampers the usefulness of MVO, since the total amount changes over time.

Table 1

 

Patients n

(%)

Positive Predictive Value %

Negative Predictive Value %

Accuracy %

LGE

(>20% LV mass)

13 (44%)

53,8

93,8

72.4

MVO (present)

15 (51%)

46.7

100

72.4

LVEF

(< 50%)

14 (48%)

50.0

100

75.9

Area at risk (>40% LV mass)

9

(31%)

55.5

90

79.3

Myocardial Haemorrhage

8

(27%)

87.5

100

96.5

Conclusion

T2-STIR images allow a long-term prognostic stratification of unrivalled accuracy during the acute phase of MI. The use of gadolinium do not significantly improve the prognostic accuracy of CMR.

Copyright information

© Monti et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

Authors and Affiliations

  • Lorenzo Monti
    • 1
  • Elena Corrada
    • 1
  • Patrizia Presbitero
    • 1
  • Renato Bragato
    • 1
  • Mirko Curzi
    • 1
  • Luca Balzarini
    • 1
  1. 1.Istituto Clinico HumanitasRozzanoItaly

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